Understanding each condition, and the relationships between them

My friends and I have a small wager resting on your answer to: Can Insulin Resistance be present in both Cushing’s Disease AND Equine Metabolic Syndrome? Also any advice you can share to help us remember which condition is which and how to tell them apart would be most appreciated! – CB, Nevada

Dear CB,
I hope the wager involves chocolate and that you were the one correctly voting “yes” that insulin resistance CAN be present in both Cushing’s Disease and Equine Metabolic Syndrome.

As luck would have it, I recently attended the 2013 AAEP Annual Convention, which featured an entire half day on Geriatric Medicine/Metabolics. While it can be challenging to keep up with all the new information associated with these two separate but related conditions, the fact that multiple teams of researchers across the US are actively researching the underlying causes, best diagnostics, and most appropriate treatments is a good thing for our aging equine population.

In a nutshell, Cushing’s Disease, or Pituitary Pars Intermedia Dysfunction (PPID), is a collection of clinical signs due to overproduction of certain pituitary hormones. It is caused by an enlarged and overactive pituitary gland normally kept in check by inhibitory dopamine from the hypothalamus. PPID is a commonly diagnosed disease in the senior equine population, affecting over 20% of horses more than 15 years of age. Common signs include weight/muscle loss, behavioral changes, secondary infections, and changes in haircoat. Laminitis may also occur.

Equine Metabolic Syndrome, or EMS, is a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses. Faulty insulin metabolism is a key component of EMS and can include both insulin resistance (IR) and hyperinsulinemia. IR is the failure of tissues to respond appropriately to insulin while hyperinsulinemia means elevated levels of insulin in the blood. Collectively they are referred to as “insulin dysregulation,” the new term you may hear veterinarians using or read in magazine articles, which simply means an excessive insulin response to sugar.

Here’s where it gets tricky (as if it wasn’t tricky enough already!): horses with EMS always have insulin resistance while horses with PPID may or may not have it. Since researchers now believe the laminitis associated with these two conditions stems from faulty insulin metabolism, horses suspected of having either EMS or PPID should be tested for insulin resistance. This means that in addition to whatever testing your veterinarian suggests to diagnose PPID—such as a resting ACTH sample or the TRH Stimulation Test—a separate test should also be performed to check insulin status.

There are two recommended tests to check insulin status in the horse: the oral sugar test and the fasting insulin concentration. Both are easy to perform on site (no hospital stay required) but the oral sugar test is more sensitive and therefore recommended as the first choice.

This may seem like a lot of complicated information when all you really want to know is if your horse has one of these conditions and if so, how to treat and manage it. However, it’s important to have some grasp of the underlying problem in EMS, PPID with insulin resistance, and PPID without insulin resistance so that the appropriate nutrition, management, and prescription medication (if necessary) can be started. For example, while oxidative stress is a factor in all three conditions—and for which antioxidants like Vitamin E are recommended—only horses with faulty insulin metabolism really need the sugars and starches in their diets limited. So a horse with PPID that has normal insulin function can and should have access to high-quality hay, pasture, and other forage sources to help maintain gut health and good weight.

While I may not have simplified things for you and your friends, hopefully this cutting edge information on two very common conditions in horses has given you some food for thought!

Lydia F. Gray, DVM, MA
SmartPak Staff Veterinarian and Medical Director
Dr. Lydia Gray has earned a Bachelor of Science in agriculture, a Doctor of Veterinary Medicine (DVM), and a Master of Arts focusing on interpersonal and organizational communication. After “retiring” from private practice, she put her experience and education to work as the American Association of Equine Practitioner’s first-ever Director of Owner Education. Dr. Gray continues to provide health and nutrition information to horse owners through her position at SmartPak, through publication in more than a dozen general and trade publications, and through presentations around the country.
She is the very proud owner of a Trakehner named Newman that she actively competes with in dressage and combined driving. In addition to memberships in the USDF and USEF, Dr. Gray is also a member of the Illinois Dressage and Combined Training Association (IDCTA). She is a USDF “L” Program Graduate and is currently working on her Bronze Medal.
Find Dr. Gray on Google+

I have a 15 y/o American Saddlebred with Cushings and is IR as well, I have a question on how this disease effects the muscles as I see there are many opinions out there that do not specify this as a common side effect….I have intermitent lameness that is not foot related and x-rays were clean….I have therapy for him 2 x’s a month and he does swim quite often in a free swim facility. He’s developed several strange muscle lumps that are not painful to the touch but seem odd. Your help is appreciated.

Jani,
your situation proves just how complicated and confusing metabolic and endocrine problems are in horses. In general, Cushing’s Disease leads to muscle atrophy or breakdown, but if you feel your horse has not “read the book” when it comes to these conditions I highly recommend you speak with your veterinarian about your concerns. He or she (sometimes with the help of a second opinion from a referral center or teaching hospital) may recommend additional diagnostic testing or adjustments in prescription medication, diet, and management to cope with unusual findings. – Dr. Lydia Gray

Thank you Dr. Gray for you explanation. What is your suggestion on where to learn about horse diseases with out going to vet school. I have been out of horses for a while and there are a lot of new things out here. It can be confusing. Thank you.

Hi Kelly, thanks for asking!
I can steer you toward a few more resources if you’re interested in learning more about equine health.
SmartPak’s Equine Health Library is chock-full of good information, so that would be a fun place to start.
I’d recommend you continue to browse the SmartPak Blog as well. Also, the most important resource regarding equine health conditions will be your veterinarian. Your vet is the absolute best resource for understanding your horse’s unique health needs, and so I would encourage you to keep that line of communication open. – Dr. Lydia Gray

Hi Chuck, it’s excellent that you’re working with your veterinarian to determine exactly what’s going on with your pony; that is absolutely the most important step! While we are aware of no issues regarding the ingredients in SmartTendon, we encourage you to discuss your pony’s complete diet, including supplements, with your vet, as you work together to develop a complete management program for him. – Dr. Lydia Gray

I have a diagnosed Cushings horse. He is 17 and has been on pergolide 2 years and is doing well. His cresty neck and fat pads are gone and his energy level is good. He is getting ribby and I can see loss of top line and muscle loss in haunches. My vet said to make sure he gets lots of work. Can I give him cocosoya to help with weight gain? His coat and hooves are good. Heavy winter coat that sheds out slowly but completely. What other supplements would help him? I want to enjoy him for many more years.

I need some help with my cushings horses. They are miniature horses. I am feeding a low starch diet, they are not on grass but are getting hay. I buy my hay in small amounts so I have not had any of it tested. The supplements they are on is Platform Performance Wellness and Evitex. One mare is doing well the other 2 are not. I have bloodwork pending ( ACTH, Insulin panel as well as a geriatric panel). I was getting pergolide (compounded powder) thru you but I can not afford the Precend. What else can I do for them? I look forward to any advice you can give me. Thank you.

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Jen and TallyApparently I've been obsessed with horses since I was born, and I used to beg for pony rides on a regular basis. I started showing in 4-H, progressed to equitation and jumpers in high school and rode on the IHSA team in college where I also discovered the joys...